Esophageal Dilatation
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ESOPHAGEAL DILATATION REASON FOR VISIT: •
Acid Peptic Stricture
•
Schatzki's Ring
•
Achalasia
•
Ingestion of Caustic Agents
•
Tumors
•
Heredity (esophageal atresia)
•
Reflux esophagitis
•
Malignant stricture
•
Benign Esophageal Strictures
RISK ASSESSMENT •
Medically unstable patients
•
Taking aspirin and other anticoagulation
•
Large aortic aneurysm
•
Pharyngeal diverticulum
•
Head and neck surgery
•
Upper gastro intestinal surgery
•
Resent perforation
•
Heart disease
•
History of bleeding disorders
•
History of allergy to medication
•
History of allergy to anesthesia
PREPARATION OF THE PATIENT •
Blood tests
•
Urine tests
•
Chest x-ray
•
EKG/ECG
•
Patient was on fasting for ___hrs before the procedure
•
Aspirin and other blood-thinning medications were stopped for
•
several days before the test. Preoperative antibiotics were given to the patients with diseases of the heart valves
ANESTHESIA •
Local anesthesia
POSITION OF THE PATIENT: •
Sitting position
•
Left lateral position
THE PROCEDURE Types of Dilators •
Balloon dilators
•
Simple dilators (Bougies)
•
Guided Wire Bougie
BALLOON DILATATION •
Balloon dilation done directly through an endoscope.
•
The endoscope was placed and visualized the stricture through
•
the endoscope and then Passed the balloon through the instrument channel while it’s still
•
deflated,” Keeping the stricture in the middle of the balloon and then
•
inflated it to _______ diameter. Balloons inflated to sizes from _____ to ____ mm.
•
The desired diameter of lumen was reached based on the
•
pressure of the balloon. The balloon was inflated to the desired diameter; it is kept in
•
place for a short time before deflating. The balloon was deflated and taken out and
•
Through the endoscope the dilatation and bleeding was
•
visualized The endoscope was withdrawn slowly.
SIMPLE DILATORS (BOUGIES) /GUIDED WIRE BOUGIE DILATATION•
_____mm dilator was passed through the mouth and down
•
through the esophagus. Progressively larger bougies were passed through the mouth and
•
down the esophagus. And using a wire dilated the stricture.
•
And dilatation confirmed by the endoscope /x-ray.
AFTER PROCEDURE: •
Patient transferred to a recovery room for further monitoring.
•
Observe for signs and symptoms of bleeding.
DURATION ________minutes POSTOPERATIVE CARE •
Take antibiotic treatment as prescribed.
•
Take normal diet after _______ hr.
COMPLICATIONS • • • •
Odynophagia Hematemesis Esophageal Perforation Mediastinitis
Acid Peptic Stricture
•
Schatzki's Ring
•
Achalasia
•
Ingestion of Caustic Agents
•
Tumors
•
Heredity (esophageal atresia)
•
Reflux esophagitis
•
Malignant stricture
•
Benign Esophageal Strictures
RISK ASSESSMENT •
Medically unstable patients
•
Taking aspirin and other anticoagulation
•
Large aortic aneurysm
•
Pharyngeal diverticulum
•
Head and neck surgery
•
Upper gastro intestinal surgery
•
Resent perforation
•
Heart disease
•
History of bleeding disorders
•
History of allergy to medication
•
History of allergy to anesthesia
PREPARATION OF THE PATIENT •
Blood tests
•
Urine tests
•
Chest x-ray
•
EKG/ECG
•
Patient was on fasting for ___hrs before the procedure
•
Aspirin and other blood-thinning medications were stopped for
•
several days before the test. Preoperative antibiotics were given to the patients with diseases of the heart valves
ANESTHESIA •
Local anesthesia
POSITION OF THE PATIENT: •
Sitting position
•
Left lateral position
THE PROCEDURE Types of Dilators •
Balloon dilators
•
Simple dilators (Bougies)
•
Guided Wire Bougie
BALLOON DILATATION •
Balloon dilation done directly through an endoscope.
•
The endoscope was placed and visualized the stricture through
•
the endoscope and then Passed the balloon through the instrument channel while it’s still
•
deflated,” Keeping the stricture in the middle of the balloon and then
•
inflated it to _______ diameter. Balloons inflated to sizes from _____ to ____ mm.
•
The desired diameter of lumen was reached based on the
•
pressure of the balloon. The balloon was inflated to the desired diameter; it is kept in
•
place for a short time before deflating. The balloon was deflated and taken out and
•
Through the endoscope the dilatation and bleeding was
•
visualized The endoscope was withdrawn slowly.
SIMPLE DILATORS (BOUGIES) /GUIDED WIRE BOUGIE DILATATION•
_____mm dilator was passed through the mouth and down
•
through the esophagus. Progressively larger bougies were passed through the mouth and
•
down the esophagus. And using a wire dilated the stricture.
•
And dilatation confirmed by the endoscope /x-ray.
AFTER PROCEDURE: •
Patient transferred to a recovery room for further monitoring.
•
Observe for signs and symptoms of bleeding.
DURATION ________minutes POSTOPERATIVE CARE •
Take antibiotic treatment as prescribed.
•
Take normal diet after _______ hr.
COMPLICATIONS • • • •
Odynophagia Hematemesis Esophageal Perforation Mediastinitis
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